The American journal of emergency medicine
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Multicenter Study
The impact of SARS and COVID-19 on major trauma in Hong Kong.
The coronavirus disease 2019 (COVID-19) pandemic has been enormously disruptive and harmful to people around the world, but its impact on other illnesses and injuries has been more variable. To evaluate the ramification of infectious disease outbreaks on major traumatic injuries, we compared changes in the incidence of major trauma cases during the 2003 Severe Acute Respiratory Syndrome (SARS) period with COVID-19 in 2020. ⋯ Major trauma cases dropped by half during both the peak of the 2003 SARS and 2020 COVID-19 pandemics in Hong Kong, suggesting a trend for future pandemic planning. If similar findings are seen at other trauma centers, proactive personnel and resource allocations away from trauma towards medical emergency systems may be more appropriate for future pandemics.
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Relatively little is known about outcomes of procedural sedation in very young children. Our objective was to examine the association between procedural sedation in young children (≤ 2 years) and the incidence of sedation-related adverse events. ⋯ Young age, specifically between 13 and 24 months, was not associated with a significant difference in the incidence of adverse events.
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Case Reports
More than just gastritis: An unusual presentation of strangulated transmesenteric hernia in a pediatric patient.
Internal hernias are a rare occurrence, reported in only 0.2-0.9% of the general population, and predominantly occur in adult patients as postsurgical complications. However, internal hernias can occur in pediatric patients, typically due to herniation of bowel through congenital mesenteric defects, and are associated with high rates of strangulation or volvulus (up to 30-40%) in this population. ⋯ She ultimately went on to have ultrasound and then CT imaging that revealed a high grade bowel obstruction due to an internal hernia from a mesenteric defect for which she required emergent resection of 119 cm of necrotic bowel. Ultimately this case illustrates a fairly benign presentation of a rare etiology of pediatric vomiting and abdominal pain that if left undetected could prove fatal, and is therefore essential for the emergency clinician to consider on the differential for vomiting and nonspecific abdominal pain in the pediatric patient.
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Multicenter Study
Inflammatory markers are poorly predictive of clinical outcomes among hospitalized patients with COVID-19.
Inflammatory markers are often elevated in patients with COVID-19. The objective of this study is to assess the prognostic capability of these tests in predicting clinical outcomes. ⋯ Inflammatory markers drawn within 48 h of arrival, though often correlated with clinical outcomes, are not individually highly predictive of which patients in a predominantly older and minority population will die or require intubation, RRT, or ICU admission.
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The purpose of this study was to compare the effectiveness and safety of the metoprolol and diltiazem administration in the Emergency Department (ED) for rate control of supraventricular tachycardia. ⋯ There was no difference in acute rate control effectiveness two hours after the last bolus dose of diltiazem and metoprolol for supraventricular tachycardias. There was a significantly higher occurrence of hypotension in the diltiazem group which was driven by higher rates of diastolic blood pressures less than 60 mmHg.